title: Analysis of recreational closed-circuit rebreather deaths 1998-2010.
abstract: BACKGROUND
  Since the introduction of recreational closed-circuit rebreathers (CCRs) in 1998, there have been many recorded deaths. Rebreather deaths have been quoted to be as high as 1 in 100 users.
  
  
  METHODS
  Rebreather fatalities between 1998 and 2010 were extracted from the Deeplife rebreather mortality database, and inaccuracies were corrected where known. Rebreather absolute numbers were derived from industry discussions and training agency statistics. Relative numbers and brands were extracted from the Rebreather World website database and a Dutch rebreather survey. Mortality was compared with data from other databases. A fault-tree analysis of rebreathers was compared to that of open-circuit scuba of various configurations. Finally, a risk analysis was applied to the mortality database.
  
  
  RESULTS
  The 181 recorded recreational rebreather deaths occurred at about 10 times the rate of deaths amongst open-circuit recreational scuba divers. No particular brand or type of rebreather was over-represented. Closed-circuit rebreathers have a 25-fold increased risk of component failure compared to a manifolded twin-cylinder open-circuit system. This risk can be offset by carrying a redundant 'bailout' system. Two-thirds of fatal dives were associated with a high-risk dive or high-risk behaviour. There are multiple points in the human-machine interface (HMI) during the use of rebreathers that can result in errors that may lead to a fatality.
  
  
  CONCLUSIONS
  While rebreathers have an intrinsically higher risk of mechanical failure as a result of their complexity, this can be offset by good design incorporating redundancy and by carrying adequate 'bailout' or alternative gas sources for decompression in the event of a failure. Designs that minimize the chances of HMI errors and training that highlights this area may help to minimize fatalities.
authors.affiliation: Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Victoria, Australia. a.fock@alfred.org.au
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Fock
mesh_terms: D002423:Cause of Death; D057189:Checklist; D016208:Databases, Factual / Q000706:statistics & numerical data; D004242:Diving / Q000009:adverse effects / Q000706:statistics & numerical data*; D004867:Equipment Design / Q000401:mortality; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data*; D006804:Ergonomics; D006801:Humans; D012309:Risk-Taking; D012122:Ventilators, Mechanical / Q000706:statistics & numerical data*
keywords: deaths; diving accidents; rebreathers/closed circuit; safety; technical diving